Responsiveness of Health-Related Quality-of-life Questionnaires in Adults Undergoing Strabismus Surgery

Abstract

Objective To evaluate the responsiveness of 2 health related quality of life (HRQOL) questionnaires, the Adult Strabismus-20 (AS-20) and National Eye Institute Visual Function Questionnaire-25 (VFQ-25), to changes in HRQOL following strabismus surgery. Design Cohort study Participants 106 adults (aged 18 to 84, median 48.5 years) undergoing strabismus surgery, 80 (75%) with diplopia and 26 (25%) without diplopia. Methods All participants completed AS-20 and VFQ-25 questionnaires pre-operatively and a median of 7 (range 4 to 13) weeks post-operatively. Using pre-defined clinical criteria, post-operative outcomes were graded as either ‘success’ (n=65), ‘partial success’ (n=32) or ‘failure’ (n=9). Main outcome measures For each questionnaire, mean composite and subscale scores (ranging from 0 to 100; worst to best HRQOL) were calculated for each patient. Median change in scores pre- to post-operatively was compared for successes, partial successes, and failures, and the proportion of patients whose scores exceeded 95% limits of agreement was calculated. Results Successfully aligned diplopic patients (n=46) showed greater improvement than failures (n=7) using both the AS-20 questionnaire (21.3 [quartiles 12.5 to 35.0] vs. 8.8 [3.8 to 12.5]; P=0.002) and the VFQ-25 questionnaire (18.3 [8.6 to 26.1] vs. 8.3 [0.8 to 13.5]; P=0.02). Successfully aligned non-diplopic patients (n=19) also showed greater improvement than failures (n=2): (AS-20 23.8 [10.0 to 32.5] vs. −3.1 [−10.0 to 3.8]; P=0.05). In non-diplopic patients, changes on VFQ-25 were small but significantly greater for successes than failures (5.0 [0.0 to 10.1] vs. −15.4 [−19.4 to −11.4]; P=0.03). More successfully aligned patients showed improvement exceeding the 95% limits of agreement for AS-20 scores than VFQ-25 scores (67% vs. 65% [P=0.8] for diplopic patients and 63% vs. 21% [P=0.005] for non-diplopic patients). Conclusions AS-20 and VFQ-25 questionnaires are responsive to improved HRQOL in adults undergoing successful strabismus surgery. Changes on VFQ-25 were smaller, particularly for non-diplopic strabismus. The AS-20 is more responsive than the VFQ-25 across the range of adult strabismus.

Improvement in patients' quality-of-life following strabismus surgery: evaluation of postoperative outcomes using the Adult Strabismus 20 (AS-20) score

“…Our postoperative AS-20 score of 73 compares favourably with other authors'. Hatt et al 13,14 analysed 73 consecutive adults in a cohort study and found an average postoperative score of 78 at 6 weeks, although this did improve to 86 at 1 year. Certainly, the sizeable and statistically significant improvement in scores would support existing evidence that the psychosocial implications of strabismus are improved by surgery.…”

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

“…Table 2 lists the utilities of these complications and the source of each value. 4,6,15,16,20,33,38,42,54,57,69,70,84,92,97 Recurrence rates after each surgical strategy were estimated by meta-regression and are illustrated in Fig. 2.…”

The impact of strabismus on quality of life in adults with and without diplopia: a systematic review

“…Although the VFQ-25 identifies poorer QoL in patients with diplopic strabismus as they have more vision-related difficulties, it has a weaker discriminatory ability in non-diplopic patients. 20 This measure does, however, respond to improvements in QoL after successful surgery 20 and has excellent testeretest reliability. It is prone to ceiling effects, however, as adults with strabismus cluster towards the normal end of the range.…”